Fecal Impaction Research Articles

Effect of Vaginal Estrogen on Pessary Use

(Abstracted from Int Urogynecol J 2016;27:1423–1429) A simple, noninvasive, treatment option for patients with pelvic organ prolapse (POP) or stress urinary incontinence is the pessary. Serious adverse effects associated with its use, such as fistula development, fecal impaction, or hydronephrosis, are rare and almost always result from neglected pessary care.

Gastrointestinal Dysmotility in the Elderly.

The number of persons 60 years and older has increased 3-fold between 1950 and 2000. Aging alone does not greatly impact the gastrointestinal (GI) tract. Digestive dysfunction, including esophageal reflux, achalasia, dysphagia, dyspepsia, delayed gastric emptying, constipation, fecal incontinence, and fecal impaction, is a result of the highly prevalent comorbid conditions and the medications with which those conditions are treated. A multidisciplinary approach with the expertise of a geriatrician, gastroenterologist, neurologist, speech pathologist, and physical therapist ensures a comprehensive functional and neurological assessment of the older patient. Radiographic and endoscopic evaluation may be warranted in the evaluation of the symptomatic older patient with consideration given to the risks and benefits of the test being used. Treatment of the digestive dysfunction is aimed at improving health-related quality of life if cure cannot be achieved. Promotion of healthy aging, treatment of comorbid conditions, and avoidance of polypharmacy may prevent some of these digestive disorders. The age-related changes in GI motility, clinical presentation of GI dysmotility, and therapeutic principles in the symptomatic older patient are reviewed here.

A Modification of the Heineke–Mikulicz Concept Applied to the Treatment of Congenital Anal Stenosis

Abstract Introduction: Anal stenosis is a rarely seen type of anorectal malformation for which a variety of treatments have been described, including cutback anoplasty, posterior sagittal anorectoplasty (PSARP), and a formal anoplasty, all done with or without colostomy, with inpatient stays and a significant anorectal dissection. The aim of this video is to demonstrate the use of an innovative and less invasive technique to treat congenital anal stenosis in a 2-year-old boy. Materials and Methods: The patient presented with recurrent episodes of constipation and fecal impaction from birth. He was found on examination to have anal stenosis, with a 2 mm depth of narrowed area and healthy rectum more proximal to this. Under general anesthesia, he was positioned prone, traction silk stitches were placed on the anal skin circumference, and radial incisions were made using cautery on the skin and adjoining mucosa, sequentially, at the 12, 3, 6, and 9 o'clock positions to release the stenosed ring. The resultin...

Prevalence and factors associated with faecal impaction in the Spanish old population.

Faecal impaction (FI) is a common problem in old people living in nursing home. Its prevalence and associated factors remain unknown in the general population. To evaluate FI prevalence in the Spanish population older than 65 years and to assess the factors associated with it. A telephone survey was carried out of a Spanish population older than 65 years random sample (N = 1000). FI was assessed using a previously validated questionnaire. A total of 28,128 calls were made; 1,431 subjects were eligible and 1,000 subjects were enrollled, mean aged 74.6 ± 7.3 (65–97); 57.5% were women. At least 53 people reported FI within the past year (5.3% (CI 95%: 3.9–6.7%)). Only 0.03% met criteria for chronic constipation and faecal incontinence. FI-associated factors were constipation, female gender, reduced physical activity, and chronic renal failure (CRF). FI is a prevalent problem in old Spanish population. Constipation and female gender are the main associated factors; low physical activity and CRF appear to play also a significant role. Further studies are required to confirm this association.

Bacteriological quality evaluation of seawater and oysters from the Hansan-Geojeman area in Korea, 2011-2013: impact of inland pollution sources.

From 2011 to 2013, we conducted a full sanitary survey of pollution sources in proximity to a shellfish growing area in the Hansan-Geojeman region in Korea, which includes a designated shellfish growing area. In the sea area, 1152 seawater and 209 oyster samples were collected and examined to evaluate their bacteriological quality. There were 758 potential pollution sources in the drainage area, including 40 sources discharging water in 2013. Fecal coliform (FC) concentrations and impact radii of discharges ranged from 1.8 to 700,000 MPN/100 mL and from 3 to 600 m, respectively; however, the pollutants did not reach the designated area. This demonstrates that the dilution of waste was sufficient such that no significant impact occurred within the designated shellfish growing area. The variation in the FC levels of seawater was closely related to season and rainfall. The FC levels of seawater and oysters from the designated area met the regulation limits set by various countries. No pathogens were found in any oysters. The results of the survey indicate that the oysters produced in this area are apparently safe for raw consumption based on their bacterial quality.

Fecal Impaction in the Emergency Department: An Analysis of Frequency and Associated Charges in 2011.

The aim of this study was to analyze the incidence and associated charges of fecal impaction for trends in hospital and patient demographics in emergency departments (ED) across the United States. In 2010, an ICD-9-CM code (560.32) for fecal impaction was introduced, allowing for assessment of fecal impaction incidence. Data were obtained from the National Emergency Department Sample records in which fecal impaction (ICD-9-CM code 560.32) was first listed as a diagnosis in 2011. In 2011, there were 42,481 [95% confidence interval (CI), 39,908-45,054] fecal impaction ED visits, with an overall rate of 32 fecal impaction visits per 100,000 ED visits. Adjusted for inflation in 2014 dollars, the associated mean charge of a fecal impaction ED visit was $3060.47 (95% CI, $2943.02-$3177.92), with an aggregate national charge in the US of $130,010,772 (95% CI, $120,688,659-$139,332,885). All charges were adjusted for inflation and reported in 2014 dollars. Late elders (85+ y) had the highest rate of fecal impaction ED visits, followed by early elders (65 to 84 y). Medicare was the primary payer for the greatest number of fecal impaction ED visits accounting for nearly two thirds of visit payments. This study reports previously unexplored statistics on the number, frequency, and associated charges of ED visits with a primary diagnosis of fecal impaction, a condition found most commonly among elders.

Naloxegol: A Novel Therapy in the Management of Opioid-Induced Constipation.

Opioid-related bowel dysfunction is a common and potentially severe adverse effect from treatment with opioid analgesics. Its development is not dose related, nor do patients develop tolerance. Opioid-induced constipation (OIC) can lead to fecal impaction, bowel obstruction, and bowel perforation as well as noncompliance with opioid analgesics and poor quality of life. Routine administration of laxatives is necessary to maintain bowel function, and, in refractory cases, other modalities must be pursued. Available options are limited but include peripherally acting μ-opioid receptor antagonists (PAMORAs), including methylnaltrexone. Naloxegol is a newly developed PAMORA that is available through the oral route. At the therapeutic dose of 25 mg daily, naloxegol is effective and safe, with a limited side effect profile and is associated with preservation of centrally mediated analgesia. In this article, we discuss the pharmacokinetics, pharmacodynamics, adverse effects, clinical trials, and cost considerations of naloxegol. Finally, we discuss its potential role as a novel key treatment for OIC in palliative medicine patients.

Soap Suds Enemas Are Efficacious and Safe for Treating Fecal Impaction in Children With Abdominal Pain.

Constipation is a common cause of pediatric abdominal pain and emergency department (ED) presentation. Despite the high prevalence, there is a dearth of clinical information and wide practice variation in childhood constipation management in the ED. The objective of the study was to assess the efficacy and safety of soap suds enema (SSE) in the therapy for fecal impaction in children with abdominal pain within the pediatric ED setting. The primary outcome was stool output following SSE. Secondary outcomes were adverse events, admissions, and return visits within 72 hours. The present study is a retrospective cross-sectional study performed in the ED at a quaternary care children's hospital of patients seen during a 12-month period who received an SSE for fecal impaction. Five hundred twelve patients (53% girls, median age 7.8 years, range: 8 months-23 years) received SSE therapy during a 1-year period. Successful therapy (bowel movement) following SSE occurred in 419 (82%). Adverse events included abdominal pain in 24 (5%) and nausea/vomiting in 18 (4%). No SSE-related serious adverse events were identified. Following SSE, 405 (79%) were subsequently discharged, of which 15 (3.7%) returned to the ED for re-evaluation within 72 hours. SSE is an efficacious and safe therapeutic option for the acute treatment of childhood fecal impaction in the ED setting.

Comparison of the effectiveness and safety of polyethylene glycol with and without electrolytes in the treatment of chronic constipation

Abstract Introduction To compare the effectiveness and safety of polyethylene glycol with and without electrolytes (EL) over a 12 week period in treatment of chronic constipation in paediatrics. Material and methods This was an observational, prospective, longitudinal, parallel group study, including 62 children with chronic constipation according to ROME III criteria and a history of faecal impaction. The children were divided into groups, one group of 30 received polyethylene glycol without EL (PEG) and 32 PEG with EL (PEG + EL) for at least 12 weeks. The main outcomes were the number of bowel movements at 6 and 12 weeks, and the presence of electrolyte disturbances at 6 weeks. Results The mean weekly stool frequencies were similar in both groups at 6 and 12 weeks, with 5.4 and 4.6 stools per week in the PEG + EL and PEG groups, respectively at 12 weeks. After 6 weeks of treatment, 83% (25 of 30) of the PEG group had at least one electrolyte disturbance compared with 56% (18 of 32) in the PEG + EL group (P = .02). Hyponatraemia was found in 15% (5 of 32) vs. 36% (11 of 30) of PEG + EL and PEG groups, respectively (P = .05). None of the laboratory abnormalities were clinically relevant. Conclusions PEG formulations with or without EL have a quite similar effectiveness, safety and acceptability. PEG without EL produced more electrolyte abnormalities, but none of them were symptomatic.

How to use a plain abdominal radiograph in children with functional defecation disorders

Defecation-related functional gastrointestinal disorders (FGIDs), such as infant dyschezia, functional constipation and functional non-retentive faecal incontinence, as defined by the Rome IV criteria, are common problems in childhood. The symptomatology...

Appendectomy Performed Routinely in the Laparoscopic Treatment of Endometriosis

INTRODUCTION: Our aim was to evaluate the relevance of performing concomitant appendectomy for patients undergoing laparoscopic surgical treatment of endometriosis by assessment of appendiceal pathology. METHODS: Laparoscopic appendectomy was performed on 79 sequential women undergoing laparoscopic treatment of endometriosis between January 2011 and December 2013. The same surgeon performed all appendectomies. Patients undergoing excision and treatment of endometriosis received simultaneous appendectomy at the time of laparoscopic surgery as part of a comprehensive management of endometriosis. All appendectomies were performed using the Altrus thermal device (ConMed). RESULTS: Abnormal pathology of the appendix included fibrosis, fecalith, follicular lymphoid hyperplasia and fecal impaction in addition to the diagnoses designated as significant pathology. Significant pathology was defined as endometriosis, acute focal inflammation, early acute appendicitis or carcinoid tumor. 38/79 (48.1%) of patients had abnormal pathology and 11/79 (13.9%) demonstrated significant pathology. Average age for patients with normal pathology was 34.8 years and for patients with abnormal pathology the average age was 35.02 years. In this cohort, there were no surgical complications related to appendectomy. 3/79 (3.8%) of patients had a complication of surgery related to the extent of endometriosis. CONCLUSION: Pathology of the appendix is seen in a surprisingly high proportion of patients with surgically diagnosed endometriosis. Patients should be counseled that appendectomy performed at the time of laparoscopic surgical treatment of endometriosis may concomitantly treat benign or significant pathology of the appendix and should be considered as an important component of management.

Injection sclerotherapy using aluminum potassium sulfate and tannic acid in the treatment of symptomatic rectocele: A prospective case series

IntroductionAlthough various surgical techniques have been described for the treatment of rectocele, there is currently no method exhibiting overall superiority because of the different types of complications and varying rate of recurrence. The aim of this study was to evaluate the outcomes of injection sclerotherapy using aluminum potassium sulfate and tannic acid in the management of symptomatic rectocele. MethodsTwelve patients were recruited and treated using injection sclerotherapy. Efficacy measures included changes in the Constipation Scoring System value and rectocele size. ResultsThe median operative duration was 7.5 min (range, 3–16 min). Three months after treatment, the mean Constipation Scoring System value decreased significantly in comparison with the baseline value (8.9 ± 4.1 vs. 4.9 ± 2.8, P = 0.0014) and the mean rectocele size reduced significantly in comparison with the baseline size (3.8 ± 0.5 vs. 1.7 ± 0.9, P < 0.001). Regarding complications, a patient showed temporary fecal impaction after treatment. The recurrence rate at 4 years was 29% (95% confidence interval, 10%–66%). ConclusionsInjection sclerotherapy is quick, easy to perform, and offers reasonable mid-term outcomes; furthermore, it is associated with a low rate of complications. Therefore, it appears to be a reasonable alternative for patients with symptomatic rectocele.

Traitements de la constipation du nourrisson et de l’enfant

Functional constipation is a common pediatric problem in general practice and even more so in pediatric gastroenterology clinics. Treatment is often delayed with psychosocial and digestive consequences. However, treatment is well codified and effective. Hyperosmotic mineral water, diet, and endoanal medications are not treatments for established constipation, whatever the age. The lactulose/lactitol-based medications are authorized and effective before 6 months of age and polyethylene-glycol for infants over 6 months. Mineral oil is less prescribed. The rule for treatment is a sufficient dose for a long time. In case of fecal impaction with or without fecal incontinence, the first stage is fecal disimpaction, using a high dose of PEG the first few days, or repeated phosphate enemas. Education regarding the adaptation of toilets and a daily bowel movement should restore colic motility and avoid relapses when the treatment is discontinued. Psychological concerns should be evaluated and treated.

Supporting patients to manage faecal incontinence.

British Journal of NursingVol. 25, No. 7 RegularsSupporting patients to manage faecal incontinenceSue WoodwardSue WoodwardSearch for more papers by this authorSue WoodwardPublished Online:15 Apr 2016https://doi.org/10.12968/bjon.2016.25.7.370AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Beeckman D, Woodward S, Rajpaul K, Vanderwee K (2011) Clinical challenges of preventing incontinence-associated dermatitis. Br J Nurs 20(13): 784–6,788,790. doi: https://doi.org/10.12968/bjon.2011.20.13.784 Link, Google ScholarBritish Society of Gastroenterologists (2016) Clinical Commissioning Report: Faecal Incontinence. http://tinyurl.com/gpp8es9 (accessed 5 April 2016) Google ScholarBurch J, Collins B (2010) Using biofeedback to treat constipation, faecal incontinence and other bowel disorders. Nurs Times 106(37): 18–21 Medline, Google ScholarCotterill N, Norton C, Avery KN, Abrams P, Donovan JL (2008) A patient-centered approach to developing a comprehensive symptom and quality of life assessment of anal incontinence. Dis Colon Rectum 51(1):82–7 Crossref, Medline, Google ScholarNational Institute for Health and Care Excellence (2007) Faecal incontinence in adults: management. [CG49]. http://tinyurl.com/zyvoey4 (accessed 5 April 2016) Google ScholarNorton C, Chelvanayagum S, eds (2004) Bowel Continence Nursing. Beaconsfield Publishers, Beaconsfield Google ScholarTariq SH (2007) Constipation in long-term care. J Am Med Dir Assoc 8(4):209–18 Crossref, Medline, Google ScholarWoodward S (2012) Management options for faecal incontinence. Nursing and Residential Care 14(5): 224–229 Link, Google Scholar FiguresReferencesRelatedDetails 14 April 2016Volume 25Issue 7ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 15 April 2016 Published in print 14 April 2016 Information© MA Healthcare LimitedPDF download

Protocolo terapéutico del estreñimiento crónico y sus complicaciones

IntroductionConstipation is a common digestive symptom, which generates a significant impact on quality of life, so it is essential to choose effective therapies for their control. Individualized treatmentTreatment should be individualized, considering the age, frequency and stool characteristics, duration of clinical manifestations, patient perception, etc. Most respond to conventional treatment (general measures and laxatives), although there is a small group with a poor response. These will require specific studies of anorectal and colonic functional studies in each subgroup to indicate the most appropriate treatment. ComplicationsComplications associated with constipation include especially anorectal disease (hemorrhoids, anal fissure, rectal prolapse, fistulas). More can be seen exceptionally colon volvulus, the stercoral ulcer or fecal impaction.

MP74-15 BLADDER OUTLET PROCEDURES ARE AN EFFECTIVE TREATMENT OPTION FOR PATIENTS WITH URODYNAMICALLY-CONFIRMED DETRUSOR UNDERACTIVITY WITHOUT BLADDER OUTLET OBSTRUCTION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2016MP74-15 BLADDER OUTLET PROCEDURES ARE AN EFFECTIVE TREATMENT OPTION FOR PATIENTS WITH URODYNAMICALLY-CONFIRMED DETRUSOR UNDERACTIVITY WITHOUT BLADDER OUTLET OBSTRUCTION Bradley Potts, Michael Belsante, Andrew Peterson, and Ngoc-Bich Le Bradley PottsBradley Potts More articles by this author , Michael BelsanteMichael Belsante More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , and Ngoc-Bich LeNgoc-Bich Le More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1712AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor underactivity (DU) is an important cause of bladder emptying dysfunction, and it is only distinguished from bladder outlet obstruction (BOO) with pressure-flow urodynamic studies (UDS). Because sparse published information exists regarding the management of DU patients without associated BOO, we set out to investigate the surgical procedures that have been used for such patients and their associated outcomes. METHODS We performed an IRB approved retrospective review of patients who underwent UDS at our institution (1996-2014). We included males age >18 years with emptying symptoms, bladder contractility index <100, and BOO index <40. We excluded the following known causes of DU: concomitant BOO on UDS, diabetes, pelvic radiation, and neuropathology (stroke, congenital/degenerative disease, trauma/surgery). We defined success as no future retention or symptoms requiring urinary catheterization/subsequent operations. RESULTS We identified 139 patients with median follow-up (FU) of 10 mos. (IQR = 1-36) after UDS diagnosis. Most patients were managed with either medication alone (37%) or urinary catheterization +/- medication (30%). Only 21 patients (15%) received bladder outlet surgery (14 TURPs, 6 KTPLAPs, and 1 bladder-neck incision). Types of DU in this group included detrusor hyperactivity with impaired contractility (10, 48%), isolated DU (6, 29%), and acontractile bladder (AB) (5, 24%). Success was achieved in 18 (86%) of patients undergoing bladder outlet procedures with postoperative FU of 6 mos. (IQR = 1-18). Failure occurred in 3 cases: 1) an isolated DU patient with UTI and retention 10 days postop; 2) an AB patient with UTI and retention 15 days postop; and 3) an isolated DU patient with fecal impaction and retention 3 mos. postoperatively. In the latter 2 cases, patients resumed volitional voiding without further difficulty. Using the same methods, we also identified 5 patients with DU who then had radical prostatectomy for prostate cancer. In this group, success occurred in all 5 (100%) cases with FU 45 mos. (IQR = 6-81). CONCLUSIONS Though infrequently used, bladder outlet procedures are an effective treatment option for patients with UDS-diagnosed DU without BOO. We recommend considering the procedure in all patients with medication-refractory DU. Our post-prostatectomy results may be considered when discussing treatment options with prostate cancer patients who also have DU. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e975 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Bradley Potts More articles by this author Michael Belsante More articles by this author Andrew Peterson More articles by this author Ngoc-Bich Le More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fecal impaction: a systematic review of its medical complications.

BackgroundFecal impaction (FI) is a common problem in the elderly and other at-risk groups, such as patients with a neuro-psychiatric disease. It has been associated with medical problems and high morbi-mortality. A systematic review of this topic might be useful to improve the knowledge in this area and helpful to make an appropriate and early diagnosis.MethodsA PubMed systematic search was performed using relevant keywords. Case reports published in English, Spanish or French till June 2014 were included if they had a diagnosis of FI and a medical complication secondary to it. Each case was classified based on its principal complication. The main objective is to create a classification of FI complications based on published clinical cases.Results188 articles met inclusion criteria, comprising 280 clinical cases. Out of the total, 43,5 % were over 65 years old, 49 % suffered from chronic constipation, 29 % had an underlying neuropsychiatric disease and 15 % were hospitalised or institutionalised. A total of 346 medical complications secondary to FI were collected. They were divided according to gastrointestinal tract involvement and then classified based on their anatomical and pathophysiological mechanism into three groups: Complications secondary to fecaloma effect on the intestinal wall (73.4 %), on the intestinal lumen (14 %) and on adjacent structures (12.6 %).ConclusionsFI causes complications that might be fatal. The elderly, underlying neuropsychiatric disease and hospitalised or institutionalised patients integrate the high-risk group in which FI must be suspected. The first FI complications classification is presented to improve the knowledge about this entity.

Use of polyethylene glycol in functional constipation and fecal impaction.

The objective of this study was to evaluate in an analytical and descriptive manner the evidence published so far on the use of polyethylene glycol (PEG), with or without electrolytes, in the management of functional constipation and the treatment of fecal impaction. Search on MEDLINE, EMBASE and Cochrane databases until May 2016 of all publications adjusted to the following terms: constipation AND/OR fecal impaction AND (PEG OR polyethylene glycol OR macrogol OR movicol OR idralax OR miralax OR transipeg OR forlax OR golytely OR isocolan OR mulytely) NOT colonoscopy. Critical reading of selected articles (English or Spanish), sorting their description according to group age (adult/pediatric age) and within those, in accordance with study features (efficacy evaluation versus placebo, doses query, safety, comparison with other laxatives, observational studies and monographic review articles of polyethylene glycol or meta-analysis). Fifty-eight publications have been chosen for descriptive analysis; of them, 41 are clinical trials, eight are observational studies and nine are systematic reviews or meta-analysis. Twelve clinical trials evaluate PEG efficacy versus placebo, eight versus lactulose, six are dose studies, five compare polyethylene glycol with and without electrolytes, two compare its efficacy with respect to milk of magnesia, and the rest of the trials evaluate polyethylene glycol with enemas (two), psyllium (one), tegaserod (one), prucalopride (one), paraffin oil (one), fiber combinations (one) and Descurainia sophia (one). Polyethylene glycol with or without electrolytes is more efficacious than placebo for the treatment of functional constipation, either in adults or in pediatric patients, with great safety and tolerability. These preparations constitute the most efficacious osmotic laxatives (more than lactulose) and are the first-line treatment for functional constipation in the short and long-term. They are as efficacious as enemas in fecal impaction, avoid the need for hospital admission and are well tolerated by patients (mainly when administered without electrolytes).

Post-procedure adhesive arachnoiditis following obstetric spinal anaesthesia.

Sir, Adhesive arachnoiditis is a crippling disorder in which the pia-arachnoid undergoes extensive inflammatory reactions to injurious stimulus, resulting in subarachnoid scarring. A Swedish study reports the incidence of neurological complications as one case per 2834 subarachnoid blocks and at least one permanent damage for every 923 epidural blocks.[1] A Finnish study reports an incidence of serious complications as 0.45/10,000 for intrathecal and 0.52/10,000 for epidural blocks.[2] A 35-year-old mother with no significant medical history, in her second pregnancy, underwent spinal anaesthesia for an elective caesarean section at 40 weeks gestation at another hospital. As per the information obtained, spinal anaesthesia in sitting position was performed with due aseptic precautions in L2-L3 interspace using 10% povidone-iodine (betadine™) solution. The cerebrospinal fluid (CSF) tap could be obtained on the second attempt. After aspiration of clear, free-flowing CSF, 12 mg of 0.5% hyperbaric bupivacaine was administered. Surgery proceeded uneventfully. On the second post-operative day, on the removal of the urinary catheter, the patient complained of urinary incontinence with the loss of sensation over the perineal area and buttocks. Gradually she also complained of constipation, following which an enema was given on the fourth post-operative day. She passed stool but, subsequently, lost her bowel control too. The patient was referred 11 days post-partum to our centre with signs of S2-S4 radiculopathy, urinary retention, constipation with faecal impaction, loss of sensation over buttocks and perineal area with weak perianal reflex. All her records from the previous hospital were obtained. A thorough examination demonstrated localised unilateral right-sided sensory loss over T11-T12 dermatome. The rectum was hugely loaded with faecal matter. A lumbosacral spine magnetic resonance imaging (MRI) [Figure 1] showed thickening, clumping and nodular enhancement of cauda equina nerve roots, suggestive of arachnoiditis. CSF analysis showed mild lymphocytosis.Figure 1: Axial magnetic resonance imaging of lumbosacral spine T2 weighted, the arrow showing thickening, clumping and nodular enhancement of cauda equina nerve roots-suggestive of arachnoiditis (likely post-surgery/procedure)A neurosurgical opinion was taken and the patient was put on a short course of steroids (tablet deflazacort six mg thrice daily). She was asked to undergo physiotherapy and was also suggested transcutaneous electrical nerve stimulation therapy. The patient was discharged to a rehabilitation centre where she received oral methylprednisolone 16 mg once daily for 7 weeks with gabapentin 100 mg thrice daily for 3 weeks. A repeat MRI 2 months later showed mild enhancement of cauda, clumping of root and resolution compared to the previous MRI. The patient was advised pelvic floor exercises with dietary adjustments to control the faecal incontinence. Steroids were tapered over 2 months after reviewing her 30 days later. She was advised to remove catheter under medical guidance and watch for retention and bladder sensation. At 12 months follow-up, the patient has significantly regained her bladder control. There was still considerable impairment in bowel control. The anal tone had not completely resolved till the date of submission of this manuscript. Contamination of intrathecal local anaesthetic drugs with noxious chemicals has been widely suggested as an aetiology in cases of adhesive arachnoiditis; phenolic, acidic and detergent contaminants all being known neurotoxic agents.[34] Alcoholic chlorhexidine, in 2008, was the identified as a culprit in a case of arachnoiditis in a trial held at the United Kingdom.[5] We considered povidone-iodine contamination as a possibility in this case, by contamination of the injectate or improper cleaning of povidone iodine from the skin before proceeding with the subarachnoid block. Without more definitive data, neuraxial blocks should be done under stringent aseptic, atraumatic techniques after discarding all sources of contamination. It also seems pertinent to explain to patients the risks of late, permanent neurological deficit while obtaining informed consent. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement This case study was supported by the entire Department of Anaesthesiology and Intensive Care Medicine, B. R. Singh Hospital, Eastern Railway, Kolkata. We are also thankful to the Department of Gynaecology and Obstetrics, B. R. Singh hospital, the nursing staff and attendants for the support in patient care and to the patient and her family for giving consent to proceed with submission for publication of the report.

Spectrum of MDCT Findings in Bowel Obstruction in a Tertiary Care Rural Hospital in Northern India.

Multidetector Computed Tomography (MDCT) provides clinically and surgically important information in bowel obstruction. It can depict the severity, level and cause of obstruction. To depict the spectrum of MDCT findings in cases of small and large bowel obstruction. Contrast enhanced MDCT examination of 50 patients were retrospectively included in the study who had evidence of clinical as well as MDCT evidence of bowel obstruction and in whom surgical/clinical follow-up for final diagnosis was available. CT scan was done in all the patients with Ingenuity CT (128 slice MDCT, Philips Medical Systems). The axial sections were reconstructed in coronal and sagital planes to determine site and cause of bowel obstruction. There were 34 males and 16 females patients in this study with mean age of 28.4 years. The level of obstruction was in small bowel in 39 patients (76.67%) and large bowel in 11 patients (23.33%). Adhesive bands were the cause of Small Bowel Obstruction (SBO) in 17 patients (43.5% of SBO patients). The most common CT signs in adhesive band SBO were beak sign (seen in 70.6% patients) and fat notch sign (52.9% patients). Five cases of SBO were secondary to benign stricture. Matted adhesions were the cause of obstruction in 3 patients. All these patients showed transition zone in pelvis with positive small bowel faeces sign. Two patients with SBO due to adhesive band had evidence of closed loop obstruction with evidence of gangrenous gut on surgery. Large Bowel Obstruction (LBO) was seen in 11 patients. Most common cause of LBO was primary colonic malignancy, accounting for 7 patients (63.6%). In one patient, the cause was direct invasion of hepatic flexure by carcinoma of gall bladder. Other causes of LBO were pelvic adhesions, faecal impaction and ischaemic stricture. SBO is more common than LBO with adhesive bands being the most common cause of SBO. MDCT is very useful for depicting site and cause of obstruction and any associated complications.